King/Drew Medical Center Disconnects Monitors After Two Patient Deaths
Martin Luther King Jr./Drew Medical Center officials on Tuesday announced that the hospital is disconnecting a new $411,000 wireless patient monitoring system after two patients died this summer when the alarms failed to alert nurses that the patients needed urgent medical care, the Los Angeles Times reports. The monitoring system transmits blood pressure, heart rate, blood oxygen level and temperature information for as many as 60 patients to a central station, which was supposed to alert nurses with an audible alarm if a patient needs immediate attention. Although the patient deaths remain under investigation, it appears that the monitor's alarms did not alert the nurses of the situations for different reasons in each case, the Times reports. According to Welch Allyn, the manufacturer of the system, the first patient death on June 30 occurred after the alarm at the central station failed to sound because the incorrect identification code had been entered for the patient. The second patient death on July 15 occurred after the central alarm may not have sounded because of damage to the main console, a Welch Allyn spokesperson said.
The families of the two patients said they were never told by the hospital that the monitors had malfunctioned. Laura Sarff, a nurse and director of quality improvement for the Los Angeles County Department of Health Services, said she had not received any reports of the monitor malfunctioning since the two patient deaths, but she added that experts hired by the county would need to conduct additional tests. The decision to disconnect the monitors comes "just weeks" after Welch Allyn and Los Angeles County, which owns the hospital, said a damaged part of the system had been replaced and could be safely used, the Times reports. The hospital may reconnect the system after the county health department concludes its investigation. Sarff also said the health department is investigating why the patients' families were not told of the problems with the monitors and how the monitors came to be purchased; the hospital's nurses had endorsed a different monitoring system (Weber/Ornstein, Los Angeles Times, 9/10).
In related news, KCRW's "Which Way, L.A.?" on Tuesday discussed King/Drew's graduate medical education accreditation rating and the implications of a second unfavorable rating for the provision of care with Los Angeles Times staff writer Charles Ornstein (Olney, "Which Way, L.A.?," KCRW, 9/9). The full segment is available online in RealPlayer.This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.